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Cryopen Injury

Discussion in 'General Issues and Discussion Forum' started by pinfold, Apr 10, 2013.

  1. pinfold

    pinfold Welcome New Poster

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    I have recently purchased a Cryopen C and an injury has occured.

    Firstly, the cartidges were only lasting about 10 seconds before running out, and I ended up using 3.

    I told the patient to advise me when they started to feel pain. Unfortunately, they did not, as they thought they would get a better result if they held on until it was no longer bearable!

    They returned after the weekend due to the amount of pain, and a result it appears as though the tissue surrounding the VP became saturated, burst and a blood blister 3cm by 3cm has been created. I suspected possible cellulits and refered him stratight to the GP for anti-biotics. GP does not suspect cellulitis, but has aired on the side of caution.

    Reading other peoples experiences, some of them say that they do 2x30 secs. Mine didn't last that long and my patient developed this blister.

    Firstly, is this normal? I very much doubt it

    Secondly, I am currently offloading with 5mm SCF with aperture. Does anyone have any other suggestions?

    Thirdly, how long do you think it will take to heal? This person is in their 60's, but they do not have diabetes or any arthritis.
  2. Simon Ross

    Simon Ross Active Member

    Sorry, but I can't advise you on the use of the Cryopen.

    What I can say is that, did you know that VP treatments are very high up the litigation tables and complaints to SCP!

    The best advise that I have is give the patient as much information as you can verbally, get them to sign a consent form which clealy states the information given verbally, and give them an information leaflet.

    I generally only put a blade to a mosaic VP. Acids/freezing just do not work in general.

    I am influenced by a lecture by Ivan Bristow.
  3. carol

    carol Active Member

    I haven't used a cryopen either. I thought they were extortionately expensive and doubted their cost effectiveness in private practice. Like Simon, regular paring and neat tree oil is my preferred treatment.
    I would hope the area would heal in about three to four weeks with care and sterile dressings. There will be scarring. Lesson learned...
  4. plevanszx1

    plevanszx1 Active Member

    I carried out both nitrous oxide and liquid nitrogen cryotherapy in my district general hospital for many years .i also did hyfrecation. I never produced scarring from cryosurgery no matter how large the haematoma. Hyfrecation often produced scarring but it was always a flat scar so no problem to walk on. I also froze hand warts also without scarring. Tissues on the hands aRe more susceptible to scarring than the tough skin. the most susceptible layer to damage is the malpighian so that a colour change is likely. I also found asian skin more susceptable to the freeze processc in terms of application time.
    Peter Evans
  5. pinfold

    pinfold Welcome New Poster

    Hi Peter

    Thank you for your reply, which I found reassuring.

    My patient is fairly active and would like to start exercising, such as cycling, as soon as possible.

    When do you think he will be able to start doing this again?

    Thanks again
  6. plevanszx1

    plevanszx1 Active Member

    Hi Pinfold
    I should point out that most of my patients were children ,teenagers and young adults and a smaller number of older people. The haematoma needs to be debrided and the resultant wound fully protected. I am assuming that you patient has intact sensation and is not diabetic. though i did warts on young well controlled diabetics. If their sensation is intact
    then their foot will tell them. For an older person establish there is no age related or alcohol related or other origin neuropathy. There was one study that showed that wound scarring was reduced by pressure which may explain why none of my young restless patients did not produce scars on ulcers of plantar warts. My experience from Diabetes patients tells me will not stop them from walking unless they themselves decide due to pain. Once you have a pink dermis it will be Ok with some non-adherent protection. I have photos of a cryoprobe attack by an over the counter cryoprobe device resulting in a massive haematoma. The patient was admitted by her GP who became frightened by the result but once done the process is under way and thatis that. I saw the young patient in hospital and debrided and dressed and then saw them again as outpatient and there was no sign of the VP. Cryosurgery can produce scarring if badly overdone i have read but i never saw it

  7. carol

    carol Active Member

    Wise words Peter..
  8. drsarbes

    drsarbes Well-Known Member

    May I ask what your experience with cryosurgery was prior to using it on this patient?

    The problem with this type of treatment is that it is very difficult to actually control the amount of tissue destruction that is being done. Skin thickness varies from patient to patient and also on various locations on the foot itself. Response to cold injury is also variable.

    IMHO there are other more reliable, less painful and more successful treatments for warts than freezing them.

  9. plevanszx1

    plevanszx1 Active Member

    Dr Sarbes
    I fully agree with all that you say. In fact i eventually abandoned both cryosurgery and hyfrecation in favour of a whole range of chemical cautery because i found that i had become the podiatrist (in contrast to my colleagues) in charge of hurting people. A few feinted. Extreme cold hurts. and if you are hurting somebody 10 seconds is a long time. When i went over to Liquid nitrogen at -190 degrees C i would only apply for a few seconds and that was a big improvement but judgement in terms of application time was vital. I well recall one older lady with hand warts who complained about the amount of pain suffered when i froze some fingers on the one hand so i then said i would hyfrecate the warts on fingers on the other hand under LA. when i asked which treatment ( including the LA block) she found least painful . She replied the hyfrecation + injection was the least painfull.
    No method is bound to work and i sum up by saying what i used to say to these patients which is that '' it is one of those conditions where the treatment is worse than the condition''.
    Peter Evans


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